What Is Nail Surgery?
Nail surgery is a surgical procedure to remove a part or entire nail or toenail due to any nail defects or deformities, ensuring proper nail growth. Nail surgery is more precise in techniques that require proper attention to detail and administration. It is necessary to get clear details about the patient’s history to identify the problem and also avoid complications. The aim of nail surgery is to identify a diagnosis with adequate nail biopsy, treat the nail completely without any residues, reduce any discomfort from nail pathology, restore the normal nail appearance, and excise tumors thoroughly. It is used for taking biopsies and treating nail avulsion, onychogryposis, paronychia, hematomas, subungual foreign body, ingrown nails, pincer nails, digital myxoid pseudocyst, etc. Nail surgery helps achieve desired results, both functionally and aesthetically, if done with adequate skills.
What Are the Techniques of Nail Surgery?
The nail surgery techniques include
Intralesional Injection: Intralesional injection helps treat various inflammatory diseases of the nail unit, like psoriasis, lichen planus, and paronychia. The injection is given mostly in the nail fold and matrix rather than the nail bed as it is easier to administer, more effective, and less painful. Corticosteroids are mostly used for intralesional injection, and the other drugs used include methotrexate, bleomycin, cyclosporine, etc. Until the desired results are achieved, the injections are given at monthly intervals, and later, they get tapered to maintain the results and prevent relapse.
Ungual Biopsy: Though this technique is not widely used, it is the gold standard for any nail pathology. A nail biopsy can be taken from the nail bed, nail matrix, nail fold, and nail plate.
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Nail Bed Biopsy: It is used for diagnosing inflammatory diseases, infectious diseases, and various tumors. An adequate sample for diagnosis can be obtained from partial nail plate avulsion. The biopsy site can heal by itself without any scars.
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Matrix Biopsy: It is mostly used for diagnosing melanonychia and nail melanoma. The biopsy can be obtained from the proximal matrix; it may cause permanent dystrophy.
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Nail Fold Biopsy: The proximal nail fold overlies the middle of the distal matrix. The nail fold biopsy may damage the matrix and cause permanent dystrophy. It is mostly advised in cases of tumors, paronychia, or other connective tissue diseases.
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Nail Plate Biopsy: It can be obtained from the nail plate and a part of the hyponychium. It is used for the diagnosis of onychomycosis or other nail dermatoses.
Nail Plate Avulsion: It is used for both diagnosis and therapeutic purposes. In cases of diagnosis, it is done to expose the nail bed and nail matrix. For therapeutic purposes, it is done before a chemical or surgical matricectomy and to treat ingrown nails, onychomycosis, nail injuries, paronychia, pincer nails, etc. It may be a partial nail plate avulsion or a total nail plate avulsion.
Partial Surgical Matricectomy: It can be done by making longitudinal incisions on the depth of the periosteum from the proximal part of the matrix to the distal part of the affected area, i.e., exposed matrix, and then extending them to the lateral nail fold and also proximally to the lateral horn. If it is not removed properly, it may result in nail spicules.
Total Surgical Matricectomy: It can be done by removing the whole matrix from the proximal nail groove to the distal part of the lunula and can heal by secondary intention. If the lateral nail matrix horns are not removed properly, it may result in the regrowth of the nail plate.
Segmental Phenolization: It can be done by applying phenol to the lateral matrix, proximal nail fold, and selective nail bed, resulting in corresponding nail unit destruction. It is mostly used for lateral ingrown nails and pincer nails. It is a very simple and safer technique that is also less traumatic.
Longitudinal Matrix Excision: It is used for excising melanonychia and is a type of matricectomy that can be done by making longitudinal elliptic excision at the depth of the periosteum.
What Are the Indications For Nail Surgery?
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Diagnosis: Nail surgery can be done to obtain a nail biopsy, which can help diagnose diseases like onychomycosis, ungual psoriasis, etc.
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Paronychia: It is a bacterial infection that arises from a break in the skin, thorn prick, etc. If not treated properly, it may result in finger deformities and superficial abscesses on the fingers.
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Trauma: Any injury to the digits may result in a phalanx fracture, leading to permanent nail dystrophy.
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Onychogryposis: It refers to horn-like thickening of the nail mostly found in elderly patients.
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Ingrown Nails: It occurs from the growth of the nail into the adjacent proximal skin.
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Pincer Nails: Pincer nails refer to the over-curvature of the nails, also called tube nails. It mostly affects big toenails symmetrically, with a slight deviation of the nails longitudinally.
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Verrucae: It is caused by human papillomavirus (HPV) and affects mostly children. It appears as small hyperkeratotic nodules that are rough in texture.
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Ungual Fibrokeratomas: Ungual fibrokeratomas are more common in the periungual skin, matrix, nail bed, and under the proximal nail fold.
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Digital Myxoid Pseudocyst: It is a pseudotumor of the nail. It appears as a dome-shaped lesion in the proximal nail fold that can create pressure on the matrix, leading to a longitudinal depression in the nail plate.
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Epidermoid Carcinoma: It is the second most common malignancy of the nail and includes Bowen’s disease and squamous cell carcinoma.
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Ungual Melanoma: It is the most common malignancy of the nail. These are usually melanotic, but nail bed melanoma is often amelanotic.
Conclusion
Nail surgery is a medical procedure done to remove and restore defective or deformed nails and also to diagnose nail pathologies. These procedures are often done in the clinic under local anesthesia. The recovery period usually takes eight to ten weeks. Nail pathologies must be treated immediately, or they may cause permanent nail dystrophy. The complications associated with nail surgeries are usually very rare.
